The word cataract is derived from a Greek word meaning "waterfall" (looking through falling water). A cataract is a clouding of the naturally clear lens inside the eye. Cataracts are most commonly caused by cumulative ultraviolet exposure and by chemical changes within the lens of the eye which is thought to be part of the natural aging process. Cataracts may also result from genetic predisposition, alcohol consumption, smoking, trauma, systemic diseases, or prolonged use of certain medications. A cataract will cause a gradual decrease in vision over time. Nearly half of the population over 65 will have some degree of progressive cataract formation in their lifetime. When vision is affected such that it impedes daily activities, vision can only be restored by surgical removal of the cataract. Routine eye examination is necessary to diagnose and track this common condition.
CATARACT SURGERY
Before the age of modern microsurgical techniques, cataract surgery would only be performed when the cataract reached a ripe or disabling stage such that a person could no longer see adequately to read or drive. In the past, cataract surgery involved prolonged hospitalization and immobilization for long periods of time after surgery. Today, cataract surgery is quite a different experience. Cataract surgery typically occurs in an outpatient facility and takes 20-30 minutes to be performed. After a brief time in recovery and informed of post-operative instructions, the patient is able to return home. In the days following surgery, patients experience very little alteration in routine daily activities. The goal of cataract surgery is to restore optimum vision with less dependence on eyeglasses.
INTRAOCULAR LENS IMPLANT (IOL)
During cataract surgery, tiny instruments are used to break apart and remove the cloudy lens from inside the eye. A plastic, acrylic, or silicone intraocular lens is implanted in the eye to replace the eye's natural lens that was removed. Based on a patient's individual needs and lifestyle requirements different options are available in IOL selection. As with contact lens development, in recent years beneficial advances in IOL technology now offer patients precise astigmatism correction, simultaneous far and near vision, and protective UV blocking capabilities.
Monofocal IOL: Monofocal IOL's are used for the majority of patients. Monofocals provide excellent quality of vision but are limited by a fixed focal distance. This means that a patient will still require eyeglasses to satisfy full-range vision after cataract surgery. Prior to surgery the patient and the surgeon will discuss all options and mutually decide on the desired post-operative focus range of the implanted monofocal IOL. Most standard monofocal IOL’s also do not correct for typical aberrations of the eye. This often results in reduced night vision and contrast sensitivity. It is common for government and private insurance plans to pay for cataract surgery and monofocal IOL's.
Multifocal IOL:A multifocal IOL differs from a one-focus monofocal IOL by providing vision correction at more than one focus range. Depending on IOL design, this generally means vision capability at distance, intermediate range, and near vision without eyeglasses. On occasion, and also depending on IOL design, glasses may assist certain tasks but the goal of this option is to be free of glasses most of the time. Multifocal IOL designs may cause some halos around lights which typically becomes less of an observed issue with the passage of time. A multifocal IOL is considered a premium surgical option. As a result, government and private insurance carriers will pay the cost for the surgical procedure but the cost of the premium IOL is not covered in full and becomes an out-of-pocket expense for the patient.
Toric IOL: A toric IOL is designed to correct for patients who have astigmatism. A toric IOL will optimize distance vision when a patient has significant amounts of astigmatism. This design of IOL is also considered a premium surgical option. As a result, government and private insurance carriers will pay the cost for the surgical procedure but the cost of the premium IOL is not covered in full and becomes an out-of-pocket expense for the patient.
Blue-Blocking/Aspheric IOL: One of the latest advancements in IOL design is the new blue-blocking/aspheric IOL. It is generally considered an option for patients that have or who are at risk for macular degeneration. This IOL blocks a specific wavelength or zone of light that are considered more harmful to these patients.